协和医学杂志

2016, v.7(05) 334-341

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2015年北京协和医院细菌耐药性监测
Surveillance of Antimicrobial Resistance in Peking Union Medical College Hospital in 2015

张小江;杨启文;王瑶;孙宏莉;王贺;郭丽娜;赵颖;窦红涛;刘亚丽;徐英春;
ZHANG Xiao-jiang;YANG Qi-wen;WANG Yao;SUN Hong-li;WANG He;GUO Li-na;ZHAO Ying;DOU Hong-tao;LIU Ya-li;XU Ying-chun;Department of Clinical Laboratory,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

摘要(Abstract):

目的了解2015年北京协和医院临床分离细菌对抗菌药物的耐药性。方法收集2015年1月1日至12月31日北京协和医院临床分离的5746株非重复细菌,采用纸片扩散法或自动化仪器法进行药敏试验,按美国临床实验室标准化协会2015年版标准判读药敏结果,采用WHONET 5.6软件进行数据分析。结果 5746株非重复细菌中,10种最常见细菌分别为:大肠埃希菌(19.4%)、铜绿假单胞菌(11.3%)、肺炎克雷伯菌(10.9%)、金黄色葡萄球菌(9.8%)、鲍曼不动杆菌(9.6%)、粪肠球菌(6.5%)、B群链球菌(5.1%)、屎肠球菌(4.6%)、凝固酶阴性葡萄球菌(2.7%)、阴沟肠杆菌(2.5%)。其中革兰阴性菌占67.5%,革兰阳性菌占32.5%。耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(methicillin-resistant coagulase-negative Staphylococcus,MRCNS)的检出率分别为22.9%和77.6%。MRSA和MRCNS菌株对β内酰胺类和其他抗菌药物的耐药率明显高于甲氧西林敏感金黄色葡萄球菌(methicillin-susceptible Staphylococcus aureus,MSSA)和甲氧西林敏感凝固酶阴性葡萄球菌(methicillin-susceptible coagulase-negative Staphylococcus,MSCNS)菌株。仍有88.8%的MRSA对磺胺甲噁唑-甲氧苄啶敏感。MRCNS中有81.7%的菌株对利福平敏感。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。粪肠球菌对大多数抗菌药物(除氯霉素外)的耐药率要明显低于屎肠球菌。两者中均有少数万古霉素耐药株,未发现对利奈唑胺耐药的肠球菌。β溶血链球菌对青霉素的敏感率为90.8%。产超广谱β-内酰胺酶的大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌的检出率分别为52.3%(582/1112)、28.9%(200/692)和26.2%(27/103)。肠杆菌科细菌对碳青霉烯类仍高度敏感,总耐药率≤4.3%。泛耐药肺炎克雷伯菌的检出率为3.0%(19/630)。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为76.5%和74.8%,对头孢哌酮-舒巴坦和米诺环素的耐药率最低,分别为49.8%和21.8%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为16.6%和11.9%,对阿米卡星的耐药率最低(5.2%)。泛耐药鲍曼不动杆菌和铜绿假单胞菌的检出率分别是20.8%(115/553)和1.8%(12/650)。结论细菌耐药性仍对临床构成严重威胁,临床需合理规范应用抗菌药物,避免耐药菌株的广泛传播。
Objective To investigate the antimicrobial resistance of clinical bacterial isolates in Peking Union Medical College Hospital( PUMCH) in 2015. Methods A total of 5746 non-duplicate clinical isolates from January 1 to December 31 2015 were collected. Disc diffusion test( Kirby-Bauer method) and automatedsystems were employed to detect the antimicrobial resistance. The data were analyzed by WHONET 5. 6 software according to 2015 edition of antimicrobial susceptibility testing standards issued by The Clinical and Laboratory Standards Institute( CLSI) of the United States. Results Of the 5746 clinical isolates,the 10 most common bacteria were: Escherichia coli( 19. 4%), Pseudomonas aeruginosa( 11. 3%), Klebsiella pneumoniae( 10. 9%),Staphylococcus aureus( 9. 8%),Acinetobacter baumannii( 9. 6%),Enterococcus faecalis( 6. 5%),Streptococcus agalactiae( 5. 1%),Enterococcus faecium( 4. 6%),coagulase-negative Staphylococcus( 2. 7%),and Enterobacter cloacae( 2. 5%). Gram-negative bacilli and gram-positive cocci accounted for 67. 5% and32. 5%,respectively. Among Staphylococcus aureus and Staphylococcus isolates,methicillin-resistant Staphyloccus aureus( MRSA) and methicillin-resistant coagulase-negative Staphylococcus( MRCNS) accounted for 22. 9%and 77. 6%,respectively. The resistance rates of MRSA and MRCNS strains to β-lactams and other antimicrobial agents were much higher than those in methicillin-susceptible Staphylococcus aureus( MSSA) and methicillin-susceptible coagulase-negatible Staphylococcus( MSCNS) strains. 88. 8% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole,while 81. 7% of MRCNS strains were susceptible to rifampin. No staphylococcal strain resistant to vancomycin,teicoplanin,or linezolid was detected. The resistance rate of E. faecalis strains to most of the antimicrobial agents tested( except Chloramphenicol) was much lower than that of E. faecium,while some strains resistant to vancomycin were found in both species. No linezolid-resistant Enterococcus strains was found. 90. 8% of β-hemolytic streptococcus strains were susceptible to penicillin. Extended-spectrum β-lactamase( ESBL)-producing strains accounted for 52. 3%( 582 /1112),28. 9%( 200 /692),and 26. 2%( 27 /103) in E. coli,Klebsiella spp( K. pneumoniae and K. oxytoca),and P. mirabilis,respectively. Enterbacteriaceae strains were still highly susceptible to carbapenems,with an overall resistance rate of ≤4. 3%. A few extensively-resistant strains of K. pneumoniae( 3. 0%,19 /630) were identified. About 76. 5% and 74. 8% of A. baumannii were resistant to imipenem and meropenem,while the resistant rates to cefoperazone-sulbactam( 49. 8%) and minocycline( 21. 8%) were the lowest. The resistance rates of P. aeruginosa to imipenem and meropenem were 16. 6% and 11. 9%,respectively,while the resistant rate( 5. 2%) to amikacin was the lowest.The prevalence of extensively-resistant strains in A. baumannii and P. aeruginosa were 20. 8%( 115 /553) and1. 8%( 12 /650),respectively. Conclusions Antibiotic resistance may still pose a serious threat to clinical practice. Rational use of antibiotics should be required to prevent the spread of antimicrobial resistant strains.

关键词(KeyWords): 细菌耐药性监测;抗菌药物;广泛耐药菌;药敏试验
antimicrobial resistance surveillance;antimicrobial agents;extensively drug-resistant bacteria;antimicrobial sus ceptibility testing

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作者(Author): 张小江;杨启文;王瑶;孙宏莉;王贺;郭丽娜;赵颖;窦红涛;刘亚丽;徐英春;
ZHANG Xiao-jiang;YANG Qi-wen;WANG Yao;SUN Hong-li;WANG He;GUO Li-na;ZHAO Ying;DOU Hong-tao;LIU Ya-li;XU Ying-chun;Department of Clinical Laboratory,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

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